Stamford Advocate

‘Unopposed estrogen’ poses little risk

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: My question concerns the benefits and risks of taking oral estrogen following removal of ovaries and uterus due to my concerns about ovarian cancer. I have recovered well from having this laparoscop­ic-robotic surgery. I am a healthy 69-year-old with a family history of ovarian cancer (mother) and breast cancer (mother and sister). The genetic testing ordered by my primary care doctor was negative for BRCA1 and 2 mutations. The specialist recommende­d removing the uterus at the same time since it would give me the option of taking oral estrogen, which could have many benefits. I have not decided on taking estrogen yet. I am concerned whether that would increase my risk of breast cancer and if there are other risks to consider.

B.W.

Answer: There are some risks and some benefits to taking estrogen, but no authoritie­s recommend taking estrogen in order to prevent future problems.

An increased risk of breast cancer is clear among women taking combined estrogen and progestins; however, there seems to be little or no risk among women who take estrogen without a progestin (called “unopposed estrogen”). One large study showed even a reduced risk of breast cancer. Other risks include an increase in blood clots. The associatio­n between estrogen and heart disease remains uncertain, but it appears that women over 65 have a greater risk from heart disease than women within a few years of menopause (who may have a reduced risk of heart disease with unopposed estrogen). Estrogen reduces the risk of osteoporot­ic fractures and of colon cancer as well as diabetes risk.

Dear Dr. Roach: My sister has been unable to find out if any of the COVID shots available are preservati­vefree. She won’t get the shots until this is an option.

L.B.T.

Answer: Neither the Pfizer nor the Moderna vaccine contain preservati­ves. I hope this reassures her. The new variants of the virus are much more easily transmissi­ble. More than 99% of people admitted to the hospital with COVID-19 now are unvaccinat­ed, as the vaccine offers very high protection.

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